Background: The superior hypogastric plexus (SHGP) carries afferents from the viscera
of the lower abdomen and pelvis. Neurolytic block of this plexus is used for reducing
pain resulting from malignancy in these organs. The ganglion impar (GI) innervats the
perineum, distal rectum, anus, distal urethra, vulva, and distal third of the vagina. Different
approaches to the ganglion impar neurolysis have been described in the literature.
Objectives: To assess the feasibility, safety, and efficacy of combining the block of the
SHGP through the postero-median transdiscal approach with the GI block by the transsacro-
coccygeal approach for relief of pelvic and/or perineal pain caused by pelvic and/or
perineal malignancies or any cancer related causes.
Methods: Fifteen patients who had cancer-related pelvic pain, perineal pain, or both
received a combined SHGP neurolytic block through the postero-median transdiscal
approach using a 20-gauge Chiba needle and injection of 10 mL of 10% phenol in saline
plus a GI neurolytic block by the trans-sacro-coccygeal approach using a 22-gauge 5 cm
needle and injection of 4 – 6 mL of 8% phenol in saline. Pain intensity (measured using
a visual analogue scale) and oral morphine consumption pre- and post-procedure were
measured.
Results: All patients presented with cancer-related pelvic, perineal, or pelviperineal
pain. Pain scores were reduced from a mean (± SD) of 7.87 ± 1.19 pre-procedurally to
2.40 ± 2.10 one week post-procedurally (P < 0.05). In addition, the mean consumption
of morphine (delivered via 30 mg sustained-release morphine tablets) was reduced from
98.00 ± 34.89 mg to 32.00 ± 28.48 mg after one week (P < 0.05). No complications or
serious side effects were encountered during or after the block.
Limitations: This study is limited by its small sample size and non-randomized study.
Conclusion: A combined neurolytic SHGP block with GI block is an effective and safe
technique for reducing pain in cancer patients presented with pelvic and/or perineal pain.
Also, a combined SHGP block through a posteromedian transdiscal approach with a GI
block through a trans-sacrococcygeal approach may be considered more effective and
easier to perform than the recently invented bilateral inferior hypogastric plexus neurolysis
through a transsacral approach.